Maeng Daniel D, Graboski Anthony, Allison Peiling L, Fisher Dorothy Y, Bulger John B
Department of Epidemiology and Health Services Research, Geisinger Health System.
Geisinger Health Plan, Danville, PA.
J Pain Res. 2017 May 31;10:1337-1346. doi: 10.2147/JPR.S135813. eCollection 2017.
To assess the impact of a value-based insurance design providing enhanced access to physical therapy (PT) for treatment of back pain on treatment patterns and cost of care.
A retrospective analysis of claims data obtained from Geisinger Health Plan (GHP). In April 2013, GHP began offering "PT bundle" - i.e., a bundle of up to five PT visits for a single one-time copay that can be renewed for another bundle of five PT visits - for its employer-based plan members with back pain.
A cohort of GHP members who were preauthorized for the PT bundle were compared against a contemporaneous cohort of GHP members who were preauthorized for PT under the standard per-visit copay arrangement between January 2013 and October 2014.
Among the PT bundle cohort, the PT visit rate during the first 9 months since the PT preauthorization date had dramatically increased and then gradually decreased in subsequent months. The PT bundle was also associated with 29%-35% short-term reductions in emergency department visits and with 12%-20% reductions in primary care visits after 6 months. No significant impact on hospitalization or cost was observed.
Implementation of the PT bundle appears to have led to a change in the treatment pattern of back pain that is more consistent with the recommended guidelines to use more conservative management such as PT as the first-line treatment for back pain.
评估基于价值的保险设计对背痛治疗模式和护理成本的影响，该设计为物理治疗（PT）提供了更多机会。
对从盖辛格健康计划（GHP）获得的理赔数据进行回顾性分析。2013年4月，GHP开始为患有背痛的雇主计划成员提供“PT套餐”，即一次性共付费用可享受多达五次PT就诊，可再续订另一组五次PT就诊。
将一组预先批准使用PT套餐的GHP成员与2013年1月至2014年10月期间根据标准每次就诊共付安排预先批准进行PT治疗的同期GHP成员队列进行比较。
在PT套餐队列中，自PT预先批准日期起的前9个月内，PT就诊率大幅上升，随后几个月逐渐下降。PT套餐还与急诊就诊短期减少29%-35%以及6个月后初级保健就诊减少12%-20%相关。未观察到对住院或成本有显著影响。
PT套餐的实施似乎导致了背痛治疗模式的改变，这种改变更符合推荐的指南，即使用更保守的管理方法，如将PT作为背痛的一线治疗方法。
